Online Interventions

Question 1

OVERLAPPING CONCEPTS

Answer 1

• mHealth (mobile) + Telehealth + apps + web-based

Question 2

FU ET AL. (2020): DIGITAL PSYCHOLOGICAL INTERVENTIONS FOR MENTAL HEALTH PROBLEMS IN LMICs

Answer 2

• many studies in high-income countries
• BUT concerns about applicability of approach in LMICs
• found 24 studies; 22 incl. in meta-analysis
• countries = China (n = 6); Iran (n = 3); Brazil (n = 1)
• intervention formats = websites/smartphone apps/SMS/computer
• some incl. face-to-face & medicine
• common theories = substance use (motivational interviewing) & others ((mindfulness) CBT)

Question 3

SMS REMINDERS

Answer 3

• earliest attempts at mHealth
• rely on sending basic messages:
  1. typically 1-way messages from sender -> receiver
  2. BUT can build in inter-action between people

Question 4

LUND ET AL. (2014): ZANZIBAR TRIAL TO IMPROVE ANTENATAL OUTCOMES

Answer 4

• maternal/neonatal mortality = major health challenge
• SDG target 3.1 = maternal mortality; reduce global maternal mortality ratio to <70 p/10k live births by 2030
• SDG target 3.2 = newborn/child mortality; end preventable deaths of newborns/children <5y of age w/all countries aiming to reduce neonatal morality & under-5 mortality by 2030
• ANC access/use can improve such outcomes; low lvls of ANC care in sub-Saharan Africa & decreasing (50% = 1990; 46% = 2010)
• aim = 4 ANC visits at least

Question 5

LUND ET AL. (2014): WIRED MOTHERS INTERVENTIONS

Answer 5

• SMS unidirectional messages:
  1. text messages according to women’s gestational age throughout pregnancy until 6 weeks after delivery to encourage attendence to routine antenatal care/skilled delivery attendence/postnatal care
  2. SMSes spread out at start; more intensive care later
  3. sent to either woman/bf/husband if she didn’t have phone
• mobile phone vouchers to call midwife
  1. small amount of money to call -> call back

Question 6

SMS APPROACH: LIMITATIONS

Answer 6

1. assumptions that key drivers = ANC access to knowledge/remembering/individual factors
2. weaknesses:
   - access to cellphones (& distribution)
   - other key drivers of limited ANC not addressed (ie. travel costs)
   - extent to which issues cluster together (ie. limited ANC attendence may indicate multiple other issues)

Question 7

DE FILLIPPO ET AL. (2023)

Answer 7

• effects of digital chatbot on gender beliefs/exposure to IPV among young women in SA
• lack of interaction = weakness of SMSes
• IPV prevention interventions = limited reach
  CHATBOTS
• interactive digital intervention
• provide beh specific/responsive info
• reach = potentially huge

Question 8

DE FILLIPPO ET AL. (2023): CHATTYCUZ

Answer 8

• recruited women via Facebook
• intervention delivered via Whatsapp
• South Africans 18-24y
• individually randomised controlled trial (n = 19,643)
• 3 month follow up on gender attitudes & violence experience

Question 9

DE FILLIPPO ET AL. (2023): CHATTYCUZ FORMATS

Answer 9

GAMIFIED
- simple symbolic rewards to guide/motivate users through interactions
- provides critical feedback & reflection space on power in relationships/skill practice/health communication/planning for safety
NARRATIVE
- short WhatsApp messages/voicenotes etc. to create story of Sindiswa
- summarises dilemmas/reflections
- made to feel like trusted friend

Question 10

DE FILLIPPO ET AL. (2023): WHY DIFFERENT IMPACTS?

Answer 10

• narrative chatbot = less directive; allowed people to reach own conclusions compared to gamified version
• many already exposed to narrative violence stories via mass media campaigns
• gamified = forced reflection/thinking/problem-solving
  CHALLENGES
• additional support for people experiencing violence

Question 11

DIGITAL DIVIDE & GENDER

Answer 11

• OECD 2018 report; 317 million fewrer women w/access to smartphone that can access internet shaped by:
  1. affordability (aka. women less likely to work)
  2. increased divide w/more complex technology
  3. illiteracy (aka. 83% women literate compared to 91% men)
  4. social barriers (ie. family support/hinderance; increased harassment risks; male control)

Question 12

KHARONO ET AL. (2022)

Answer 12

• access to phones among young people
• cross-sectional study among 14-24ys receiving HIV treatment in Nairobi, Kenya
• 69% = access to mobile; 48% = smartphone
• access to smartphone associated w/older age/higher education/being male

Question 13

CLUSTERING OF HEALTH RISKS & LIMITED CELLPHONE ACCESS

Answer 13

• implicit assumption lit (aka. mobile/online tech will reach those most at need)
• data drawn fron ongoing survey:
  1. do you have own cellphone? if yes, can you send/receive SMSes, make/receive calls &/or get onto internet?
• in urban informal settlements 24% young women/30% young men didn’t have functional cellphone (none/aspects not working)
• prevalence associated negatively w/depression/anxiety/alcohol abuse/IPV/high school completion

Question 14

FERRETTI ET AL. (2023)

Answer 14

• what do young people have to say about digital health promotion?
• scoping review on young people’s views

Question 15

FERRETTI ET AL. (2023): BENEFITS

Answer 15

• liked nicely designed interfaces & single source of health info
• supplemental support to own attempts to change
• ability to access own non-judgemental approaches
• high value on connecting to others/sharing experiences/etc.
• privacy/confidentiality

Question 16

FERRETTI ET AL. (2023): CONCERNS

Answer 16

• technological concerns (ie. battery life/connectivity/cost)
• time to engage online
• lack of personalisation
• privacy risks
• lack of human interaction
• misinformation

Question 17

FERRETTI ET AL. (2023): UNLOCK DIGITAL HEALTH PROMOTION IN LMIC FOR YOUNG PEOPLE

Answer 17

• narrative reviw of digital health promotion in LMICs
• beyond digital divide/equitable distribution of benefits; raise range of other issues:
  1. data = harvested by large organisations for wealth creation (aka. reflects wider global health)
  2. individualised approach to health promotion; not empowerment/collective action; oft dyadic in approach
  3. pushes costs out from state/health system to individual

Question 18

FERRETTI ET AL. (2023): INCREASE DIGITAL ACCESS & LITERACY

Answer 18

• promote local tech expertise
• support local tech development & capacity building
• enhance digital literacy/health education

Question 19

FERRETTI ET AL. (2023): INVOLVE END-USERS

Answer 19

• engage users in tech co-design
• adapt technology to culture/context
• develop tech interventions that address community needs

Question 20

FERRETTI ET AL. (2023): DEPLOY SAFE TOOLS

Answer 20

• protect/minimise data collection/usage to ensure privacy
• assess tech for bias to promote fairness
• monitor quality of info for scientific reliability

Question 21

FERRETTI ET AL. (2023): ENSURE TECH OVERSIGHT

Answer 21

• strengthen role of oversight mechanisms
• define minimum ethical standards
• monitor tech value & adequacy over time

Question 22

SUMMARY

Answer 22

• online/digital health promotion offers lots of potential benefits (ie. reach/costs)
• challenges = numerous (ie. equity of access; risks of reinforcing divides & excluding those most at risk; etc.)
• for small group interventions, question = can you replicate ideas/approaches in online world?